Trans-septal approach to unilateral posterior choanal atresia

Abstract

A technique of trans-septal approach to unilateral bony choanal atresia in the older child or adult is described with the advantages of better exposure, less bleeding and better mucosal cover of raw bone than traditional methods. This seems to reduce post-operative re-stenosis at the site of the atresia.

Endoscopic fenestration of choanal atresia

“…Whilst clinical tests are helpful, axial CT scanning after preliminary prepartion with vasoconstrictor drops and suction is the investigation of choice (Morgan and Bailey, 1990;Stansbie, 1992) and indicates whether the atresia is bony or membranous. Flexible or rigid fibreoptic nasendoscopy using topical anaesthesia indicates the diagnosis and permits 'palpation' of the obstruction (Mclntosh, 1986). Dehaen and Clement (1985) and Morgan and Bailey (1990) respectively report use of 110° and 120° Hopkin's rod telescopes to visualize the post-nasal space whilst the atretic plate is perforated.…”

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

“… 13 In young patients, when the ethmoid sinuses have reached a satisfactory level of development, and in adults, it is possible to make incisions of the mucosa of the atretic plate, as reported by different authors. The most common techniques for incision are: double mucosal anterior and posterior low-hinged flap, 12 side-hinged double flap, 14 , 15 upper hinged flap, 16 four flaps with cruciate incisions, 11 , 17 , 18 double nasal and septal flap, 19 and multiple flaps secured with fibrin glue, 20 , 21 , 22 so as to obtain mucosal flaps for the re-covering of the raw areas at the level of the medial lamina of the pterygoid process and the posterior part of the septum. Other authors instead did not flap techniques, such as El-Ahl et al who performed a stentless transnasal endoscopic approach to treat bilateral CA in 7 neonates (ranging from 4 to 15 days of life) without evidence of restenosis.…”